Can the World Health Organization still be the World’s health conscience? -4 | Rebuilding the World’s health conscience
The Legitimacy cannot be decreed; it must be earned. To regain the world’s trust, WHO must relearn to listen - and to lead.
The World Health Organization’s legitimacy has never rested on coercive authority. Its strength has always come from moral credibility - from the belief that it speaks for humanity, not for power. Yet in the wake of the pandemic, that legitimacy has been shaken by charges of political deference, bureaucratic opacity, and uneven accountability.
Rebuilding trust, then, cannot be reduced to a public relations exercise or a funding appeal. It must be an act of institutional renewal - a return to the principles that once made WHO the conscience of global health. When I ask Dr. Monir Islam how such renewal could happen, he outlines a vision rooted in reform.
“Leadership and governance reform,” he begins, is essential. “The process for electing the Director-General and other senior leaders must be made more transparent, merit-based, and broadly representative. The perception, and reality, that leadership is disproportionately influenced by a few powerful Member States must be addressed head-on. WHO needs a leadership culture that is accountable to all countries, not just its largest donors or most influential political blocs.”
He moves next to the question of money - the engine and the constraint of WHO’s existence. “Financing Reform,” he says, “is long overdue. WHO’s dependence on earmarked voluntary contributions has long undermined its ability to set priorities based on global health needs. Increasing the share of assessed contributions, creating more flexible core funding, and diversifying sources of financing are critical to restoring independence and credibility.”
He argues that scarcity should also be a moment for clarity. “In the context of financial difficulties and reduced earmarked financing, WHO must also sharpen its focus on the most urgent priorities. This includes sunsetting programmes that can be more effectively handled by other institutions or partners, eliminating duplication of efforts with other relevant UN agencies, and concentrating its comparative advantage on programmes that deliver the greatest impact, particularly those that serve the needs of underserved and vulnerable countries.
This, he admits, will require difficult choices. “Although these may be difficult decisions, the time has come for WHO to make hard choices, including the closure of many expensive and underutilized country offices. In their place, WHO should consider maintaining a leaner presence through liaison officers who can coordinate and mobilize WHO expertise as needed, ensuring responsiveness without the burden of costly fixed infrastructure.”
The third reform area, Dr. Islam says, must be decentralization and empowerment of regional and country offices. Power must flow outward from Geneva to where the needs are most immediate. “Decision-making authority and technical leadership should not be overly concentrated at headquarters. WHO must invest in empowering its regional and country offices, which are closest to Member States and understand the political, social, and epidemiological realities on the ground. That shift is essential for restoring trust, especially among low- and middle-income countries.”
The fourth is structural balance and resource allocation. WHO must, he says, “forgo its top-heavy structure at all levels — headquarters, regional, and country — to ensure that resources are aligned with the organization's mission and needs on the ground. There must be a more deliberate balance in expenditure between internal human capacity and direct country support. Without this rebalancing, WHO risks remaining disconnected from the realities and expectations of its Member States.”
But reform cannot remain technical. “Reform must go beyond technical tweaks,” he emphasizes. “It requires a transformation in culture, from one that is overly hierarchical and cautious, to one that is open, accountable, and driven by WHO’s core mission: health for all.”
If these changes fail to materialize, Dr. Islam warns, the consequences will be larger than WHO itself. “If WHO fails to reform meaningfully, the vacuum in global health governance will not remain empty. Other actors - regional bodies, political blocs, development banks, public-private partnerships, and even powerful bilateral agencies - will increasingly fill that space. While some of these efforts may complement WHO, many will further fragment the global health architecture.”
As I listen to him, I am reminded that the crisis facing WHO is not only about management or money; it is about connection - about how an institution born in the ashes of world war can remain relevant to the people it was built to serve.
To the four reforms Dr. Islam outlines, I would add a fifth: WHO must reconnect with people, not only governments. In an age of digital misinformation and populist mistrust, legitimacy is not conferred solely by states but earned through public confidence. Communication must become more human - empathetic, proactive, participatory, and inclusive. The organization needs to speak not from a podium, but in a voice that resonates with those whose health and dignity it defends.
The World’s health conscience or its shadow?
As our conversation ends, I am struck by how WHO’s story mirrors that of multilateralism itself: noble in vision, flawed in execution, and yet indispensable. Its authority, once rooted in universal ideals, now wavers amid a world more divided and distrustful than at any time in recent memory. But as Dr. Islam insists, “The world still needs WHO.”
If the organization can rediscover its courage - to stand for science over politics, for equity over expedience, for moral clarity over diplomatic caution - it may yet reclaim its voice as the world’s health conscience. If not, it risks becoming only a shadow of what it was meant to be: not the guardian of global solidarity, but a casualty of its erosion.
